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 BRAND NAMES
 MECHANISM OF ACTION
Bupropion works by inhibiting the reuptake of norepinephrine and dopamine at presynaptic terminals.
- Bupropion is used to treat major depressive disorder
- Bupropion is indicated as an aid to smoking cessation treatment
- Smoking cessation treatment: The recommended dose of Bupropion is 300 mg/day, given as 150 mg twice daily. Dosing should begin at 150 mg/day given every day for the first 3 days, followed by a dose increase for most patients to the recommended usual dose of 300 mg/day. Maximum dose is 300 mg/day should. Bupropion should be initiated while the patient is still smoking, since approximately 1 week of treatment is required to achieve steady-state blood levels. Patients should quit smoking within the first 2 weeks of treatment, generally in the second week. Treatment with Bupropion should be continued for 7 to 12 weeks. If a patient has not made significant progress towards abstinence by the seventh week of therapy with Bupropion, it is unlikely that he or she will quit during that attempt, and treatment should probably be discontinued.
- Major depressive disorder: The usual adult dose is 300 mg/day. Dosing should begin at 200 mg/day, given as 100 mg twice daily. Based on clinical response, this dose may be increased to 300 mg/day, given as 100 mg 3 times daily, no sooner than 3 days after beginning therapy.
- Seizure disorders or conditions that increase the risk of seizures (bulimia or anorexia nervosa, abrupt discontinuation of alcohol or sedatives (including benzodiazepines, antiepileptics, sedative/hypnotics, barbiturates).
- MAO inhibitors: Discontinue MAOI at least 14 days prior to initiation of treatment with Bupropion.
- Hypersensitivity to bupropion (Anaphylactoid/anaphylactic reactions, erythema multiforme and Stevens-Johnson syndrome have been reported rarely)
 WARNINGS AND PRECAUTIONS
- Bupropion may cause generalized seizures in a dose-dependent manner with an approximate incidence of 0.4%. doses above 300 mg/day are not recommended.
- Hypertension, in some cases severe, requiring acute treatment, has been reported The chance of Hypertension may be higher when using nicotine (such as a nicotine patch) in Smoking cessation treatment.
- Allergic Reactions: Anaphylactoid/anaphylactic reactions characterized by symptoms such as pruritus, urticaria, angioedema, and dyspnea requiring medical treatment have been reported at a rate of about 1 to 3 per thousand in clinical trials of ZYBAN. In addition, there have been rare spontaneous postmarketing reports of erythema multiforme, Stevens-Johnson syndrome, and anaphylactic shock associated with bupropion. A patient should stop taking Bupropion and consult a doctor if experiencing allergic or anaphylactoid/anaphylactic reactions (e.g., skin rash, pruritus, hives, chest pain, edema, and shortness of breath) during treatment.
- Bupropion is primarily metabolized to hydroxybupropion by the CYP2B6 isoenzyme. Therefore, the potential exists for a drug interaction between Bupropion and drugs that are substrates of or inhibitors/inducers of the CYP2B6 isoenzyme, and dose adjustment of Buproprion may be necessary.
- Carbamazepine, phenobarbital and phenytoin can induce the metabolism of bupropion. Dose increase may be necessary
- Bupropion is an inhibitor of the CYP2D6 isoenzyme, thus it can increase serum levels of drugs that are metabolized by CYP2D6 isoenzyme including certain antidepressants (e.g., nortriptyline, imipramine, desipramine, paroxetine, fluoxetine, sertraline), antipsychotics (e.g., haloperidol, risperidone, thioridazine), beta-blockers (e.g., metoprolol), and Type 1C antiarrhythmics (e.g., propafenone, flecainide). Consider dose reduction of these drugs when using with bupropion.
 PREGNANCY AND LACTATION
- Pregnancy Category C (US). Bupropion should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus.
- Nursing mothers: Bupropion and its metabolites are secreted in human milk. Because of the potential for serious adverse reactions in nursing infants, a decision should be made whether to discontinue nursing or to discontinue the drug, taking into account the importance of the drug to the mother.
 SIDE EFFECTS
The most common side effects of Bupropion are nervousness, constipation, insomnia, dry mouth, headache, nausea, vomiting, and shakiness (tremor).
 RELATED LINKS
|Tricyclic antidepressants||Amitriptyline (Elavil, Laroxyl) • Clomipramine (Anafranil) • Doxepin (Sinequan) • Imipramine (Tofranil) • Nortriptyline (Aventyl, Pamelor) • Trimipramine (Surmontil)|
|Selective serotonin reuptake inhibitors (SSRIs)||Citalopram (Celexa, Seropram) • Escitalopram (Cipralex, Lexapro) • Fluoxetine (Prozac) • Fluvoxamine (Luvox, Maveral) • Paroxetine (Paxil, Seroxat) • Sertraline (Zoloft)|
|Serotonin–norepinephrine reuptake inhibitors (SNRIs)||Desvenlafaxine (Pristiq) • Duloxetine (Cymbalta, Xeristar) • Venlafaxine (Efexor, Effexor)|
|Serotonin antagonists and reuptake inhibitors (SARIs)||Trazodone (Desyrel, Oleptro)|
|Norepinephrine reuptake inhibitors (NRIs)||Maprotiline (Ludiomil) • Reboxetine (Edronax)|
|Norepinephrine-dopamine reuptake inhibitors (NDRIs)||Bupropion (Wellbutrin)|
|Noradrenergic and specific serotonergic antidepressants (NaSSAs)||Mianserin (Lantanon) • Mirtazapine (Remeron)|
|Norepinephrine-dopamine disinhibitors (NDDIs)||Agomelatine (Valdoxan, Thymanax)|
|Monoamine oxidase inhibitors Nonselective||Tranylcypromine (Parnate)|
|Monoamine oxidase inhibitors B-Selective||Selegiline (Transdermal) (Emsam)|
|Others||5-Hydroxytryptophan • S-Adenosyl methionine • Hypericum (St John's wort)|